Abstract:
Surgery complemented by antibiotics forms the backbone of the successful management of necrotizing fasciitis. But it will be very difficult to clear away extensive necrotizing tissue thoroughly in critically ill patients when their vital signs are unstable. The authors report the case of a 33-year-old woman who had extensive necrotizing fasciitis of the right lower limb with septic shock. The patient was severely anemic and malnutrition and had been given conservative debridement at bedside, that is, only detached necrotizing tissues was taken away while some other necrotizing tissue still remained, so that the skin tissue within the same area could be saved as much as possible. After debridement, negative pressure was applied at 125 mm Hg. Broad-spectrum antibiotics and effective supplementation were also complemented, thus controlling the septic shock. All necrotizing tissues were detached, and the sparing vital skin on necrotizing fascia was preserved successfully after negative pressure treatment. The patient was finally saved. In conclusion, negative pressure treatment may help diminish toxin absorbance, detach gangrene tissue, and preserve sparing vital tissue. This case suggests the value of combined use of negative pressure therapy and conservative debridement in critically ill patients with extensive necrotizing fasciitis.
摘要:
由抗生素补充的手术构成了成功治疗坏死性筋膜炎的支柱。但是,当危重病人的生命体征不稳定时,很难彻底清除广泛的坏死组织。作者报告了一例33岁的女性,该女性患有右下肢广泛的坏死性筋膜炎伴感染性休克。患者严重贫血和营养不良,并在床边进行了保守清创,也就是说,只有分离的坏死组织被带走,而其他一些坏死组织仍然存在,以便尽可能多地保存同一区域内的皮肤组织。清创术后,在125mmHg下施加负压。还补充了广谱抗生素和有效的补充剂,从而控制感染性休克。所有坏死组织均脱离,负压治疗后,坏死性筋膜上保留的重要皮肤得以成功保留。病人终于得救了。总之,负压治疗可能有助于减少毒素吸收,分离坏疽组织,保留重要组织。此病例提示在重症广泛坏死性筋膜炎患者中联合使用负压治疗和保守清创的价值。